Lung biomarker testing hindered by insufficient tissue samples

The biggest challenges faced in incorporating biomarker testing into the care of persons with lung cancer involve the ability to obtain tissue samples of sufficient size and quality, according to newly released survey findings. Biomarker testing, in which tissue is tested for a given genetic mutation or translocation, can be used to tailor treatment to a person’s specific type of cancer.

Following up on a series of surveys sent in 2011 to lung cancer/oncology nurses and other oncology professionals working with lung cancer patients, Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI), questioned 100 US pulmonologists and 250 US pathologists regarding the use of biomarker testing in the care of persons with lung cancer. Each group was surveyed separately, and BIPI summarized the results in a recent news release.

Nearly half of the pulmonologists surveyed (41%) did not believe they had enough information on what size tissue sample is needed to test for a given mutation. This echoed findings from the 2011 BIPI survey of 95 community oncologists, 42% of whom said they, too, did not have sufficient information about the tissue sample size needed for such testing. According to BIPI, this points to the need for consistent guidelines on the size and quality of tissue needed to perform biomarker testing.

The two new surveys also uncovered differences in preferred tissue-acquisition methods between the groups. Whereas 51% of the responding pulmonologists believed that endoscope biopsy yields the most appropriate balance between quantity and quality of tissue and risk to the patient, only 15% of pathologists agreed with that opinion.

Fine-needle biopsy was deemed the best method for obtaining tissue samples by 33% of pulmonologists but by only 10% of pathologists. Core biopsy was lauded as the most appropriate method by 63% of pathologists and 44% of pulmonologists.

The respondents were also queried about their adoption of reflex, or automatic, testing, in which tissue samples are tested for biomarkers immediately after a diagnosis of non-small cell lung cancer is made. Reflex testing enables oncologists to receive the results at the patient’s first visit so that the most appropriate treatment can be initiated as early as possible. Almost halfof the pulmonologists (43%) and one-third of the pathologists (33%) indicated that they have implemented reflex testing in their practice.

Most of the pulmonologists and pathologists (85% and 92%, respectively), reported consulting with oncologists. Both groups have increased discussions with multidisciplinary teams over the past 5 years, as noted by 65% of pulmonologists and 57% of pathologists.